I vividly remember meeting her, despite all the years that had passed. At 6 feet tall she towered over me (granted, anyone who has met me will know that’s not hard to imagine) and yes, I’ll admit it — she had physically intimidated me. But about 10 minutes into the initial consultation, I realized she was soft-spoken, kind, and, being recently diagnosed with metastatic ovarian cancer, she was scared. Surgery had not been recommended given the advanced nature of the disease, and she was sent to me to discuss medical therapy. She had been told it was not curable, had read that the prognosis wasn’t very good.
“Let’s cut to the chase, doc,” she said. “I know it’s bad, but I want as much time as I can have. I’m not ready to die.”
We discussed treatment options, and I had recommended combination chemotherapy. “It won’t cure you, but this disease tends to respond very well to treatment. Let’s see if I can get you to remission and, short of that, get this disease under control.”
“Sounds good. When do we start?”
With that she underwent chemotherapy, and we used her tumor marker (CA-125) to monitor her. She tolerated each cycle well and complained of very little. Treatment caused side effects, including the loss of her hair. Still, she managed these toxicities well. After three treatments her CA-125 started to double, which prompted repeat imaging to assess what was going on with this cancer. I feared for her — afraid the scan would show what her CA-125 was telling me, and yes — her tumors had grown despite chemotherapy, and new disease was now evident in her liver.
“How could this be?” she asked.
“I wish I knew,” I said. “Only a minority of patients with ovarian cancer don’t respond to this treatment — even if it’s for a short while. It’s clear that treatment hasn’t worked. We should try something else.”
“Like what?” she asked. I reviewed standard second-line treatment options and those available on clinical trial. We talked over pros and cons of each, expectations of benefits, potential risks. We started second-line treatment, but yet again, after multiple cycles, her CA-125 continued to increase and imaging again confirmed progression of disease. A trial came later, but again—disease progression. After yet another disappointing trial ended with disease progression and with her CA-125 now climbing into the thousands, she came to my office to discuss next steps. She was tired, frustrated, and angry that nothing had worked. I had told her the prognosis was not good — and we were running out of options. As I got ready to move on to my next recommendation, she stopped me.
“Nothing you’ve given me works. What about Essiac tea?” she asked. “It’s from Canada. A nurse used to give it to her patients, and she claims some of them were cured of cancer. It originated from an American Indian tribe and is supposed to have medicinal properties.”
I was skeptical. There was little published about it in scientific journals and the little information I found online was not encouraging. Essiac had been popular in the 1920s, after a Canadian nurse, Rene Caisse (Essiac is a backwards spelling of her name) popularized its use as a treatment for diseases, including cancer. According to a review by Barrie Cassileth, attempts to validate its cytotoxic properties were not successful, and the bulk of the evidence of its benefits lay in anecdotes and patient testimonials.
The academician inside of me wanted to tell her to forget about that, that it wouldn’t work — indeed, it would probably just make her feel sicker. However, I also had to acknowledge that my treatments had not worked. Indeed, it was likely her disease was universally chemotherapy resistant and nothing I could try from that point forward was likely to garner a response. Her prognosis was poor and her cancer approaching terminal.
Still, she maintained an excellent performance status with few toxicities related to the cancer. She had some treatment-related issues which I felt would resolve with some time off of treatment — something she had not done in months. I realized that a treatment break would be good for her, and that since I wasn’t going to be treating her with chemotherapy, it might be a good time to try this tea.
“Well, since you don’t have any cancer-related symptoms and since this is something you really want to try, I won’t stop you. I think at the very least, you could use a break from the chemotherapy. I’d like to monitor you during your break, to make sure this tea doesn’t make you sick. What about you see me monthly so I can help you manage any side effects.”
“I wouldn’t want it any other way.”
With that, she started Essiac. I saw her after one month and she felt well. The tea was bitter, but not terrible. No nausea and her hair was returning. Surprisingly, her CA-125, which had been rising almost exponentially, was stable. The next month it actually went down, and the month after, another drop. She stayed on it for months, and I was nothing short of amazed. I had to entertain the possibility that there was something to this tea, though science had failed to confirm any true antitumor activity.
Perhaps it was a placebo effect. Or maybe she had a delayed response to her last chemotherapy. Or her disease had reached a certain point where the CA-125 no longer had any room to rise. As likely, however, is the possibility that this tea, taken in this patient, had an impact on her cancer.
Later in my career I tried to study Essiac tea more formally. However, the inability to isolate an active ingredient and the problems with standardizing the amount of tea ingested per patient proved to be barriers for me. Still, I’ve learned to listen to my patients when they want to try something outside of conventional Western medicine and the realm of evidence. I’ve learned to realize that for some patients, my treatments prove to be of little value and in those circumstances, I need to keep an open mind. I have not adopted Essiac as one of my standard regimens for the treatment of ovarian cancer. But for those who request to try it, who am I to say no?
Don S. Dizon is an oncologist who blogs at ASCO Connection.
